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Oncologic safety of laparoscopic surgery after metallic stent insertion for obstructive left-sided colorectal cancer: a multicenter comparative study

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Abstract

Background

Self-expanding metallic stents (SEMSs) are used as a bridge to surgery in patients with obstructive colorectal cancer. However, the role of laparoscopic resection after successful stent deployment is not well established. We aimed to compare the oncologic outcomes of laparoscopic vs open surgery after successful colonic stent deployment in patients with obstructive left-sided colorectal cancer.

Methods

In this multicenter study, 179 (97 laparoscopy, 82 open surgery) patients with obstructive left-sided colorectal cancer who underwent radical resection with curative intent after successful stent deployment were retrospectively reviewed. To minimize bias, we used inverse probability treatment-weighted propensity score analysis. The short- and long-term outcomes between the groups were compared.

Results

Both groups had similar demographic and tumor characteristics. The operation time was longer, but the degree of blood loss was lower in the laparoscopy than in the open surgery group. There were nine (9.3%) open conversions. After adjustment, the groups showed similar patient and tumor characteristics. The 5-year disease-free survival (DFS) (laparoscopic vs open: 68.7% vs 48.5%, p = 0.230) and overall survival (OS) (laparoscopic vs open: 79.1% vs 69.0%, p = 0.200) estimates did not differ significantly across a median follow-up duration of 50.5 months. Advanced stage disease (DFS: hazard ratio [HR] 1.825, 95% confidence interval [CI]: 1.072–3.107; OS: HR 2.441, 95% CI 1.216–4.903) and post-operative chemotherapy omission (DFS: HR 2.529, 95% CI 1.481–4.319; OS: HR 2.666, 95% CI 1.370–5.191) were associated with relatively worse long-term outcomes.

Conclusion

Stent insertion followed by laparoscopy with curative intent is safe and feasible; the addition of post-operative chemotherapy should be considered after successful treatment.

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Acknowledgements

An abstract version of this article was presented at the 13th Scientific and Annual Meeting of European Society of Coloproctology 2018. None of the authors have commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, speaking fees) that may pose a conflict of interest in connection with this study. We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This work was supported by a Grant (No. 02-2018-036) from the SNUBH Research Fund.

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Author notes

  1. Min Hyun Kim and Sung Il Kang have contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea

    Min Hyun Kim, Jeehye Lee, Heung-Kwon Oh, Duck-Woo Kim & Sung-Bum Kang

  2. Department of Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea

    Sung Il Kang

  3. Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea

    Soyeon Ahn

  4. Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

    Rumi Shin & Seung Chul Heo

  5. Department of Surgery, Daehang Colorectal Hospital, Seoul, Korea

    Eui Gon Youk

  6. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Sung-Chan Park, Dae Kyung Sohn & Jae Hwan Oh

  7. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Min Jung Kim, Ji Won Park, Seung-Bum Ryoo, Seung-Yong Jeong & Kyu Joo Park

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  1. Min Hyun Kim
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the Seoul Colorectal Research Group (SECOG)

Corresponding author

Correspondence to Heung-Kwon Oh.

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Disclosures

Drs. Min Hyun Kim, Sung Il Kang, Jeehye Lee, Heung-Kwon Oh, Soyeon Ahn, Duck-Woo Kim, Sung-Bum Kang, Rumi Shin, Seung Chul Heo, Eui Gon Youk, Sung-Chan Park, Dae Kyung Sohn, Jae Hwan Oh, Min Jung Kim, Ji Won Park, Seung-Bum Ryoo, Seung-Yong Jeong, and Kyu Joo Park have no conflicts of interest or financial ties to disclose.

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Kim, M.H., Kang, S.I., Lee, J. et al. Oncologic safety of laparoscopic surgery after metallic stent insertion for obstructive left-sided colorectal cancer: a multicenter comparative study. Surg Endosc 36, 385–395 (2022). https://doi.org/10.1007/s00464-021-08293-5

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